Multilingual Support:

Concerns

Anticoagulation therapy guidelines

Antiplatelet therapy guidelines

Anticoagulation and antiplatelet therapies

Anticoagulation therapy guidelines

Routine dental care, including simple extractions, can be performed with a PT <20 seconds or an INR <3.5.
  • PT and INR should be measured within 24 hours to be considered valid.
  • Anticoagulation level is measured by prothrombin time (PT) and international normalized ratio (INR).
  • PT – Normal range is 11-13 seconds; goal for anticoagulation is 16-20 seconds.
  • INR – normal range is 1.0-1.3; goal for anticoagulation is 2.5-4.5.
  • Only a physician should make changes to a patient’s anticoagulation therapy.
  • If coumadin (Warfarin), a vitamin K antagonist, is discontinued, the effect will take place only 2 days later. If no alternative anticoagulation therapy is instituted during this time, there is an increased risk for the patient to develop a thromboembolic event.
  • Alternative anticoagulation therapy includes fractionated and unfractionated (low molecular weight heparin [LMWH]) heparin.
  • Apixaban (Eliquis), a novel direct factor Xa inhibitor, has been shown to be beneficial in patients with atrial fibrillation to prevent the incidence of strokes.
  • Other new alternatives to warfarin therapy are rivaroxaban (Xarelto), another factor Xa inhibitor, and dabigatran (Pradaxa), a direct thrombin inhibitor.

Antiplatelet therapy guidelines

  • No need to discontinue aspirin, or aspirin in combination with other antiplatelet medications, used to prevent thromboembolic events, for routine dental procedures or simple extractions.
  • DO NOT discontinue dual antiplatelet therapy in patients within the first year after the placement of  coronary artery stents.

Anticoagulation and antiplatelet therapies

Drug Category Generic name Trade name
Aspirin
  • Aspirin
  • Aspirin
Intravenous antiplatelet
(glycoprotein IIb/IIIa inhibitors)
  • Abciximab
  • Eptifibatide
  • Tirofiban
  • ReoPro
  • Integrilin
  • Aggrastat
Oral antiplatelet
(P2Y12 Inhibitor)
  • Clopidogrel
  • Prasugrel
  • Ticagrelor
  • Plavix
  • Effient
  • Brilinta
Anticoagulant
  • Apixaban*‡
  • Bivalirudin
  • Dabigatran†
  • Endoxaban*‡
  • Enoxaparin
  • Fondaparinux
  • Rivaroxaban‡
  • Unfractionated heparin
  • Warfarin
  • Eilquis
  • Angiomax
  • Pradaxa
  • Lixiana
  • Lovenox
  • Arixtra
  • Xarelto
  • Unfractionated heparin
  • Coumadin

* Not FDA approved
† anti-thrombin
‡ anti-Xa

OK